Disentangling temporal associations in marine microbial networks.

BACKGROUND: Microbial interactions are fundamental for Earth's ecosystem functioning and biogeochemical cycling. Nevertheless, they are challenging to identify and remain barely known. Omics-based censuses are helpful in predicting microbial interactions through the statistical inference of single (static) association networks. Yet, microbial interactions are dynamic and we have limited knowledge of how they change over time. Here, we investigate the dynamics of microbial associations in a 10-year marine time series in the Mediterranean Sea using an approach inferring a time-resolved (temporal) network from a single static network. RESULTS: A single static network including microbial eukaryotes and bacteria was built using metabarcoding data derived from 120 monthly samples. For the decade, we aimed to identify persistent, seasonal, and temporary microbial associations by determining a temporal network that captures the interactome of each individual sample. We found that the temporal network appears to follow an annual cycle, collapsing, and reassembling when transiting between colder and warmer waters. We observed higher association repeatability in colder than in warmer months. Only 16 associations could be validated using observations reported in literature, underlining our knowledge gap in marine microbial ecological interactions. CONCLUSIONS: Our results indicate that marine microbial associations follow recurrent temporal dynamics in temperate zones, which need to be accounted for to better understand the functioning of the ocean microbiome. The constructed marine temporal network may serve as a resource for testing season-specific microbial interaction hypotheses. The applied approach can be transferred to microbiome studies in other ecosystems. Video Abstract.

Convective drying of mango stone for use as biomass.

Mango stone is an interesting biomass by-product with a considerable net calorific value. Mango production has significantly risen in the last few years, meaning that mango waste has increased as well. However, mango stone has a moisture content of about 60% (wet basis) and it is very important to dry the samples for using them in electrical and thermal energy production. In this paper, the main parameters involved in the mass transfer during drying are determined. Drying was carried out in a convective dryer through a set of experiments based on five drying air temperatures (100 °C, 125 °C, 150 °C, 175 °C and 200 °C) and three air velocities (1 m/s, 2 m/s and 3 m/s). Drying times ranged between 2 and 23 h. The drying rate was calculated from the Gaussian model whose values ranged from 1.5·10-6 to 6.3·10-4 s-1. Effective diffusivity was obtained as an overall parameter in the mass diffusion for each test. These values were found between 0.71·10-9 and 13.6·10-9 m2/s. The activation energy was calculated from the Arrhenius law for each test, made at different air velocities. These values were 36.7, 32.2 and 32.1 kJ/mol for 1, 2 and 3 m/s, respectively. This study provides information for future works on design, optimization and numerical simulation models in convective dryers for standard mango stone pieces according to industrial drying conditions.

Niche adaptation promoted the evolutionary diversification of tiny ocean predators.

Unicellular eukaryotic predators play a crucial role in the functioning of the ocean ecosystem by recycling nutrients and energy that are channeled to upper trophic levels. Traditionally, these evolutionarily diverse organisms have been combined into a single functional group (heterotrophic flagellates), overlooking their organismal differences. Here, we investigated four evolutionarily related species belonging to one cosmopolitan group of uncultured marine picoeukaryotic predators: marine stramenopiles (MAST)-4 (species A, B, C, and E). Co-occurrence and distribution analyses in the global surface ocean indicated contrasting patterns in MAST-4A and C, suggesting adaptation to different temperatures. We then investigated whether these spatial distribution patterns were mirrored by MAST-4 genomic content using single-cell genomics. Analyses of 69 single cells recovered 66 to 83% of the MAST-4A/B/C/E genomes, which displayed substantial interspecies divergence. MAST-4 genomes were similar in terms of broad gene functional categories, but they differed in enzymes of ecological relevance, such as glycoside hydrolases (GHs), which are part of the food degradation machinery in MAST-4. Interestingly, MAST-4 species featuring a similar GH composition (A and C) coexcluded each other in the surface global ocean, while species with a different set of GHs (B and C) appeared to be able to coexist, suggesting further niche diversification associated with prey digestion. We propose that differential niche adaptation to temperature and prey type has promoted adaptive evolutionary diversification in MAST-4. We show that minute ocean predators from the same phylogenetic group may have different biogeography and genomic content, which needs to be accounted for to better comprehend marine food webs.

Comparative genomics reveals new functional insights in uncultured MAST species.

Heterotrophic lineages of stramenopiles exhibit enormous diversity in morphology, lifestyle, and habitat. Among them, the marine stramenopiles (MASTs) represent numerous independent lineages that are only known from environmental sequences retrieved from marine samples. The core energy metabolism characterizing these unicellular eukaryotes is poorly understood. Here, we used single-cell genomics to retrieve, annotate, and compare the genomes of 15 MAST species, obtained by coassembling sequences from 140 individual cells sampled from the marine surface plankton. Functional annotations from their gene repertoires are compatible with all of them being phagocytotic. The unique presence of rhodopsin genes in MAST species, together with their widespread expression in oceanic waters, supports the idea that MASTs may be capable of using sunlight to thrive in the photic ocean. Additional subsets of genes used in phagocytosis, such as proton pumps for vacuole acidification and peptidases for prey digestion, did not reveal particular trends in MAST genomes as compared with nonphagocytotic stramenopiles, except a larger presence and diversity of V-PPase genes. Our analysis reflects the complexity of phagocytosis machinery in microbial eukaryotes, which contrasts with the well-defined set of genes for photosynthesis. These new genomic data provide the essential framework to study ecophysiology of uncultured species and to gain better understanding of the function of rhodopsins and related carotenoids in stramenopiles.

Adaptación y validación de los cuestionarios de apoyo a la autonomía y estilo controlador a la educación física: relación con el feedback / Adaptation and validation of autonomy support and controller style's scales in physical education: relationship with feed-back

El objetivo de este trabajo fue adaptar y validar la Escala de Apoyo a la Autonomía (EAA-EF) y la Escala de Estilo Controlador (EEC-EF) para evaluar la percepción del estudiante del estilo interpersonal docente en educación física y comprobar su relación con el feedback El estudio 1, contempla el diseño y análisis factorial exploratorio de los instrumentos con una muestra de 272 estudiantes con una edad media de 11.05 años (DT = 0,76). En el estudio 2, los cuestionarios fueron administrados a 350 estudiantes con una edad media de 11 años (DT = 0,80). Tras el análisis factorial confirmatorio, de consistencia interna, estadísticos descriptivos, correlación de todas las variables y regresión lineal se confirma una estructura psicométrica apropiada para las escalas de apoyo a la autonomía y estilo controlador. Además, se observa cómo el apoyo a la autonomía es predicho positivamente por lo feedbacks positivos y negativamente por el negativo. En conclusión, se trata de dos instrumentos válidos y fiables para evaluar la percepción del estudiante del estilo interpersonal del docente de educación física en el escenario de enseñanza aprendizaje, siendo necesarios más estudios en este ámbito de conocimiento.

The objective of this study was to adapt and validate The Autonomy Support Scale (ASS-PE) and The Control Style Scale (CSS-PE) to evaluate teacher´s interpersonal style in Physical Education. Study 1, contemplates the design and exploratory factor analysis of the instruments with a sample of 272 students with an average age of 11.05 years (SD = 0.76). In study 2, the questionnaires were administered to 350 students with an average age of 11 years (SD = 0.80). After the confirmatory factor analysis, internal consistency and descriptive statistics, the correlation of all the variables and linear regression, an appropriate psychometric structure is confirmed for the support scales for autonomy and controlling style. In addition, it is observed how support for autonomy is predicted positively by positive feedbacks and negatively by negative feedback. The data obtained confirms an appropriate psychometric structure for ASS-PE and CSS-PE scales. In conclusion, it is a valid and reliable instrument for evaluating the interpersonal style of teacher`s physical educa-tion in the teaching learning stage

Gene Expression Profiling of Tumors From Heavily Pretreated Patients With Metastatic Cancer for the Selection of Therapy: A Pilot Study.

BACKGROUND: Recently, it has been shown that it is possible to identify tumor profiles of sensitivity for potentially useful drugs, both conventional and experimental, based on whole oligonucleotide microarray gene expression studies in heavily pretreated patients with metastatic solid tumors. METHODS: Fresh-frozen tumor biopsies for molecular profiling (MP) were obtained from patients with advanced and refractory cancer. Total tumor and control tissue RNA was hybridized to a whole human genome oligonucleotide microarray. Differentially expressed genes interacting with potential therapeutic targets were identified. Results were complemented with DNA sequencing of selected driver genes and with immunohistochemistry and fluorescent "in situ" hybridization. The results were used to guide experimental treatment. RESULTS: MP assays led to a potentially active available drug in 91.2% of the patients. The median number of available active drugs per tumor was 5 (range, 1 to 9). Nine treated patients were not evaluable for response. Partial response was observed in 18 patients (33%), stable disease in 22 patients (40%) (clinical benefit rate of 73%), and progression in 15 (27%). Overall median progression-free survival and overall survival were 8 and 13 months, respectively. CONCLUSION: MP-guided therapy is feasible and seems to improve the clinical outcome of extensively pretreated patients but prospective and confirmatory trials are needed.

Honey Bee Colonies Remote Monitoring System.

Bees are very important for terrestrial ecosystems and, above all, for the subsistence of many crops, due to their ability to pollinate flowers. Currently, the honey bee populations are decreasing due to colony collapse disorder (CCD). The reasons for CCD are not fully known, and as a result, it is essential to obtain all possible information on the environmental conditions surrounding the beehives. On the other hand, it is important to carry out such information gathering as non-intrusively as possible to avoid modifying the bees' work conditions and to obtain more reliable data. We designed a wireless-sensor networks meet these requirements. We designed a remote monitoring system (called WBee) based on a hierarchical three-level model formed by the wireless node, a local data server, and a cloud data server. WBee is a low-cost, fully scalable, easily deployable system with regard to the number and types of sensors and the number of hives and their geographical distribution. WBee saves the data in each of the levels if there are failures in communication. In addition, the nodes include a backup battery, which allows for further data acquisition and storage in the event of a power outage. Unlike other systems that monitor a single point of a hive, the system we present monitors and stores the temperature and relative humidity of the beehive in three different spots. Additionally, the hive is continuously weighed on a weighing scale. Real-time weight measurement is an innovation in wireless beehive-monitoring systems. We designed an adaptation board to facilitate the connection of the sensors to the node. Through the Internet, researchers and beekeepers can access the cloud data server to find out the condition of their hives in real time.

Sobrecarga en cuidadores informales de pacientes con Alzheimer y la relación con su ingreso salarial / Burden in caregivers of Alzheimer's disease patients, and its relation with their incomes

Resumen La sobrecarga es el resultado psicológico de combinaciones emocionales, físicas y sociales que surge al cuidar una persona enferma, especialmente si es de Alzheimer. El ingreso salarial puede repercutir en la sobrecarga, ya que hacerse responsable de un paciente genera gastos que la familia debe soportar. Este estudio correlaciona sobrecarga e ingreso salarial en una muestra por conveniencia de 100 cuidadores informales de la ciudad de Bucaramanga, aplicando la escala de sobrecarga Zarit (Martín, Salvadó, Nadal, Miji, Rico, Sanz & Taussing, 1996) y la ficha de datos sociodemográficos (Cerquera, Granados & Buitrago, 2012). Los resultados muestran que si bien la mayoría de cuidadores devengan más del salario mínimo colombiano vigente, así mismo presentan sobrecarga, y ya que no se ha establecido correlación, esto indica que el ingreso económico no es un determinante para la situación anotada.

Abstract Burden is the psychological result of emotional, physical and social combinations that come from looking after a sick person, especially if it's Alzheimer's. Wage income can affect overload, taking care of a patient generates expenses that the family must endure. This study correlates overhead and salary income in a convenience sample of 100 caregivers from Bucaramanga, using the Zarit Burden Interview (Martin et al., 1996) and Sociodemographic Data Sheet (Cerquera et al., 2012). The results show that most caregivers earn more than the Colombian minimum wage and are overloaded, not establishing correlations, indicating that wage income is not determining for overload.

Streetlight Control System Based on Wireless Communication over DALI Protocol.

Public lighting represents a large part of the energy consumption of towns and cities. Efficient management of public lighting can entail significant energy savings. This work presents a smart system for managing public lighting networks based on wireless communication and the DALI protocol. Wireless communication entails significant economic savings, as there is no need to install new wiring and visual impacts and damage to the facades of historical buildings in city centers are avoided. The DALI protocol uses bidirectional communication with the ballast, which allows its status to be controlled and monitored at all times. The novelty of this work is that it tackles all aspects related to the management of public lighting: a standard protocol, DALI, was selected to control the ballast, a wireless node based on the IEEE 802.15.4 standard with a DALI interface was designed, a network layer that considers the topology of the lighting network has been developed, and lastly, some user-friendly applications for the control and maintenance of the system by the technical crews of the different towns and cities have been developed.

Waiting times for surgical and diagnostic procedures in public hospitals in Mexico / Tiempos de espera para procedimientos quirúrgicos y diagnósticos en hospitales públicos de México

Objective. A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. Materials and methods. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Results. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). Conclusion. Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.

Objetivo. Se llevó a cabo una evaluación retrospectiva de los tiempos de espera para procedimientos electivos en una muestra de hospitales públicos en México de las siguientes instituciones: Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) y Secretaría de Salud (SS). El propósito era describir la situación actual en materia de tiempos de espera e identificar oportunidades de redistribución de la demanda de servicios entre instituciones públicas. Material y métodos. Se analizaron los tiempos de espera y la productividad para siete procedimientos quirúrgicos y cuatro procedimientos diagnósticos seleccionados sobre la base de su frecuencia relativa y comparabilidad con otros sistemas de salud nacionales. Resultados. El tiempo de espera promedio para los siete procedimientos quirúrgicos en las tres instituciones fue de 14 semanas. Los hospitales del IMSS y el ISSSTE mostraron un mejor desempeño (12 y 13 semanas) frente a los hospitales de la SS (15 semanas). El tiempo de espera promedio para los cuatro procedimientos diagnósticos fue de 11 semanas. Los hospitales del IMSS mostraron un tiempo de espera promedio mejor (10 semanas) que los hospitales del ISSSTE (12 semanas) y la SS (11 semanas). Conclusión. Se identificaron variaciones importantes no sólo entre instituciones sino también al interior de cada una de ellas. Estas variaciones deben atenderse para así mejorar la satisfacción de los usuarios de los servicios.

Waiting times for surgical and diagnostic procedures in public hospitals in Mexico.

OBJECTIVE: A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. MATERIALS AND METHODS: We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. RESULTS: Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). CONCLUSION: Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.

Political Economy of Pursuing the Expansion of Social Protection in Health in Mexico.

Abstract-This article uses political economy analysis to identify the factors that contributed to the adoption of policies to expand social protection in health (SPH) in Mexico in the early years of the 21st century. It focuses on the adoption stage of these policies to answer two questions: (1) Which contextual factors created the window of opportunity where SPH reforms could be adopted in Mexico? (2) What political strategies did the main actors driving the reform use to promote its adoption? Two types of analysis were developed: an analysis of the context and a stakeholder analysis. The analysis of the context was used to identify the "enabling factors" (epidemiological, political, and economic) that created the window of opportunity to place the problem of limited health care coverage in Mexico on the national policy agenda. The stakeholder analysis was used to (1) construct a map of actors, positions, and power during the deliberation of these policies in the Mexican Congress; (2) evaluate the behavior, intentions, interrelations, agendas, and interests of key actors; and (3) assess the influence and resources that actors brought to the debate and the strategies used by proponents to pursue and achieve adoption of the policies. This article shows that actors with high political power can take advantage of a propitious context (a window of opportunity for major change) through effective political strategies to design, promote, and successfully negotiate SPH policies, even in the absence of beneficiary mobilization. This was the case in the adoption of Mexico's health reform in 2003.

Abasto y surtimiento de medicamentos en unidades especializadas en la atención de enfermedades crónicas en México en 2012 / Supply of essential drugs in units specialized in the treatment of chronic diseases in Mexico in 2012

Objetivo. Cuantificar el abasto en farmacia y el nivel de surtimiento de medicamentos en las unidades de especialidades médicas de enfermedades crónicas (UNEMES-EC) de México. Material y métodos. Los indicadores de abasto y surtimiento se midieron en 30 de 86 UNEMES-EC existentes en el país. El abasto de medicamentos se registró mediante una lista de cotejo que incluía 17 medicamentos básicos relacionados con la atención de diabetes mellitus, hipertensión y sobrepeso/obesidad. La información sobre surtimiento de recetas procede de un cuestionario aplicado directamente a 1 200 usuarios. Resultados. Sólo 13.3% de las unidades reportó abasto completo de medicamentos esenciales y dicho abasto fue más frecuente en aquellas unidades con servicio tercerizado de farmacia. Del total de pacientes entrevistados, 35% alguna vez tuvo que comprar medicamentos con recursos propios. Conclusión. Las UNEMES-EC deben mejorar su abasto de medicamentos y el surtimiento completo de recetas para evitar que sus usuarios incurran en gastos de bolsillo.

Objective. To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. Materials and methods. The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. Results. Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. Conclusion. UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.

La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México / Burden of disease, injuries, risk factors and challenges for the health system in Mexico

Objetivo. Presentar los resultados de la carga de enfermedad en México de 1990 a 2010 para las principales enfermedades, lesiones y factores de riesgo, por sexo. Materiales y métodos. Se realizó un análisis secundario del estudio de la carga mundial de la enfermedad 2010. Resultados. En 2010 se perdieron 26.2 millones de años de vida saludable (AVISA), 56% en hombres y 44% en mujeres. Las principales causas de AVISA en hombres fueron violencia, cardiopatía isquémica y los accidentes de tránsito. En las mujeres fueron la diabetes, la enfermedad renal crónica y la cardiopatía isquémica. Los trastornos mentales y musculoesqueléticos concentran 18% de la carga. Los factores de riesgo que más afectan a los hombres son sobrepeso/obesidad; niveles de glucosa en sangre y de presión arterial elevados; y el consumo de alcohol y tabaco (35.6% de AVISA perdidos). En las mujeres, el sobrepeso y la obesidad; glucosa elevada; hipertensión arterial; baja actividad física; y el consumo de alcohol y tabaco fueron responsables de 40% de los AVISA perdidos; en ambos sexos, la dieta contribuye con 12% de la carga. Conclusiones. El panorama epidemiológico en México demanda una urgente adecuación y modernización del sistema de salud.

Objective. To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. Materials and methods. A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. Results. In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. Conclusions. The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.

[Transit of users between hospitals from different states and institutions]. / Tránsito de usuarios entre hospitales de diferentes estados e instituciones.

OBJECTIVE: To describe and quantify hospital services given by units of the Ministry of Health (MoH) to patients with social security or living in states different to those where the hospitals are located. MATERIALS AND METHODS: With data from the automatized system for hospital discharges patients were classified, according to the place of living, into locals or outsiders; and, according to their insurance status, into social security beneficiaries or not beneficiaries. Frequencies of services for these groups were estimated, and characteristics of patients and services were described. RESULTS: 5.6% of patients of MoH hospitals were outsiders. This percentage reaches 50% in the National Institutes of Health. Only 1.7% of the patients had social security insurance. Sociodemographic and services characteristics are quite different between outsiders or social security patients and those without those attributes. CONCLUSION: Despite its segmentation, in the National Health System there is a continuous process of exchange of services between different providers.

Tránsito de usuarios entre hospitales de diferentes estados e instituciones / Transit of users between hospitals from different states and institutions

OBJETIVO: Describir y cuantificar los servicios prestados en hospitales de la Secretaría de Salud a pacientes con seguridad social o que habitan en entidades distintas a la del hospital del que egresaron. MATERIAL Y MÉTODOS: Utilizando el Sistema Automatizado de Egresos Hospitalarios, los pacientes se clasificaron, según su residencia, en locales o foráneos; y por tipo de aseguramiento, en derechohabientes o no derecho-habientes. Se calculó la frecuencia de servicios otorgados y se analizaron las características diferenciales de los pacientes y los servicios. RESULTADOS: De los pacientes 5.6% fueron foráneos. En los Institutos Nacionales de Salud este porcentaje alcanzó 50%. Sólo 1.7% de los pacientes registraron ser derechohabientes. Las características sociodemográficas y del perfil de servicios son claramente distinguibles entre pacientes foráneos y derechohabientes y aquellos sin estos atributos. DISCUSIÓN: Independientemente del carácter segmentado y fragmentado del Sistema Nacional de Salud, existe un proceso de intercambio de servicios entre proveedores.

OBJECTIVE: To describe and quantify hospital services given by units of the Ministry of Health (MoH) to patients with social security or living in states different to those where the hospitals are located. MATERIALS AND METHODS: With data from the automatized system for hospital discharges patients were classified, according to the place of living, into locals or outsiders; and, according to their insurance status, into social security beneficiaries or not beneficiaries. Frequencies of services for these groups were estimated, and characteristics of patients and services were described. RESULTS: 5.6% of patients of MoH hospitals were outsiders. This percentage reaches 50% in the National Institutes of Health. Only 1.7% of the patients had social security insurance. Sociodemographic and services characteristics are quite different between outsiders or social security patients and those without those attributes. CONCLUSION: Despite its segmentation, in the National Health System there is a continuous process of exchange of services between different providers.

[Burden of disease, injuries, risk factors and challenges for the health system in Mexico]. / La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México.

OBJECTIVE: To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. MATERIALS AND METHODS: A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. RESULTS: In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. CONCLUSIONS: The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.

[Supply of essential drugs in units specialized in the treatment of chronic diseases in Mexico in 2012]. / Abasto y surtimiento de medicamentos en unidades especializadas en la atención de enfermedades crónicas en México en 2012.

OBJECTIVE: To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. MATERIALS AND METHODS: The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. RESULTS: Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. CONCLUSION: UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.

Sobrecarga en cuidadores de pacientes con demencia tipo alzheimer / Overload in caregivers for patients with alzheimer dementia

Este estudio tuvo como objetivo determinar los niveles de sobrecarga que presenta una muestra de cuidadores de pacientes con demencia tipo Alzheimer. La muestra fue seleccionada por conveniencia, la cual debería tener como labor principal el cuidado y mantenimiento de algún familiar que padezca esta enfermedad. Se evaluaron 52 cuidadores, sin distinción de edad, género, raza o religión. La evaluación de la sobrecarga se hizo a partir de la Escala de Sobrecarga del Cuidador Test de Zarit, la cual busca identificar el nivel de sobrecarga. Simultáneamente se organizaron los datos sociodemográficos y se analizaron a través del programa estadístico SPSS versión 1.9. Los resultados arrojaron que el 65.4% no presenta sobrecarga, el 17.3% presenta sobrecarga leve y el mismo porcentaje presenta sobrecarga intensa. Se determinó que los datos sociodemográficos como el alto nivel de escolaridad, el elevado estrato socioeconómico y el parentesco están relacionados con la no sobrecarga.

This study's objective was to determine the overload levels of caretakers for patients with Alzheimer dementia. The sample was selected by convenience. The main task had to be the care and support of a relative with this disease. 52 caretakers were evaluated, without regard of age, gender, race or religion. The overload evaluation was done using the Overload Scale of Caretaker Zarit Test, which seeks to identify the level of overload. Social demographic data was simultaneously organised and analysed using the SPSS version 1.9 statistics program. Results show that 65.4% did not file overload, 17.3% presents mild overload and the same percentage presents severe overload. It was determined that social demographic data such as highly educated, high socioeconomic status and relationship are related to the overload.